Dr. Al Danenberg ● Nutritional Periodontist
August 5, 2019
Figure 1 Cavitational Osteonecrosis in lower jaw (within red circle)
“Cavitation” is a term that is used to describe a dental problem in the jawbone. The general definition of a “cavitation” is: an empty space formed within a solid object or body. “Cavitation” is not a medical term although it is used in dentistry.
It seems to me that many patients are being diagnosed with “dental cavitations” in their jawbone. And of course, this could lead to an expensive surgical procedure to “repair” them – sometimes critical to be done; sometimes unnecessary.
Since “cavitation” is not a recognized dental term or condition, there is much confusion revolving around its diagnosis and treatment. In my opinion, this is leading to misdiagnosis, overtreatment, and potential fraud by poorly qualified dentists and other healthcare professionals. I want to dive into this area and present some facts about “dental cavitations”.
The medical term for a dental cavitation is reported in the literature as “cavitational osteonecrosis” or “ischemic osteonecrosis”. It is real. It may be a hollow space surrounded by dead bone or it may be filled with various inflammatory, toxic, and infectious elements.
Most of these lesions are painless. However, if pain is caused by them, they are called “Neuralgia-Inducing Cavitational Osteonecrosis” (NICO). But these bone lesions must be diagnosed correctly. “Cavitation lesions” that are only areas of demineralization with no pathology rarely need to be treated.
It is difficult or impossible to see these lesions when viewing a regular panoramic dental x-ray (See Figure 1). A panoramic x-ray shows the upper and lower jaw, the teeth, and the sinus spaces. This is a 2-dimensional picture like most dental x-rays. However, the jaw exists in three dimensions. So, the 2-dimensional panoramic x-ray flattens the 3-dimensional human jaw into a picture that shows minimal detail. More detail is required to identify potential areas of cavitational osteonecrosis.
To see this lesion in detail, the dentist should have the patient receive a 3-dimensional picture of the jaw. This can be done with a Cone Beam CT Scan of the jaw.
Also the dentist must review the dental and medical history of the patient to determine the possible causes of the bone lesion before making the diagnosis.
Causes of Dental Cavitations
These lesions could be caused by a variety of insults to the bone. Here are a few of the possible causes:
- Some type of trauma to the bone causing a blockage of blood flow could cause bone cells to die thereby creating a hollow space within the bone.
- Following an improperly performed procedure to extract a tooth could leave infection or debris in the bone socket, which could result in a dry socket and eventually a dental cavitation.
- Overheating the bone during a dental procedure using cutting drills could cause bone to die leading to cavitational osteonecrosis.
- A tooth abscess penetrating into the bone and becoming isolated could cause the bone lesion.
- Continuing infection at the base of a failing endodontically treated tooth could be the culprit.
Linking Dental Cavitations to Chronic Disease
When pathological microbes and toxic substances accumulate in the hollow space in the bone lesion, the immune system is activated. Various biologically active chemicals are produced which can travel along nerve sheaths, through bone spaces, within lymph, and into the systemic bloodstream. These elements can affect other cells and organs in the body, creating chronic systemic inflammation, chronic diseases, and chronic pain.
It is important to realize that pain and chronic disease could occur a distance from the dental cavitation lesion. This is another reason why it may be difficult to connect the dental lesion to an area of pain and chronic disease somewhere else in the body.
I selected a few recently published articles that discuss cavitational osteonecrosis and NICO:
In this 2010 peer-reviewed paper, the authors discussed 22 patients with NICO in the jawbone. They described the pathogenesis and treatment of this bone lesion for patients in this study.
In a paper published in 2012 in the National Journal of Maxillofacial Surgery, the clinicians described their diagnosis and treatment for a patient, whom they diagnosed with an isolated lesion of NICO in the lower jawbone.
The authors of this 2015 study evaluated 15 patients with atypical facial pain and trigeminal neuralgia. Their research suggested that the jawbone disease, known as “cavitations” and “NICO”, might be the cause of the jaw pain as a result of the inflammatory cytokines that these lesions produced.
In this 2017 article published in Implant Dentistry, the surgeons described their treatment for 34 patients who experienced dental cavitations in the area where dental implants were to be inserted. The dentists described how these lesions were treated prior to placing the dental implants.
Treatment of Dental Cavitations
Treatment of cavitational osteonecrosis consists of entering the lesion and cleaning it out thoroughly. The fluid and tissues removed from the lesion should be sent to pathology to be identified. The dental surgeon may use a laser to decontaminate and debride the lesion. He or she may place a biologically active material into the lesion space to enhance bone healing.
In addition to surgically treating the bone lesion, it is important to support the patient’s immune system. There should be an integrative approach including a non-inflammatory nutrient-dense diet and various spore-based probiotics to support a diverse and abundant garden of healthy microbes in the gut. Sometimes it will be necessary to determine if any toxic substances already exist in the body like heavy metals, which may need to be reduced or eliminated.
My Final Thoughts
While the medical and dental professions are not completely convinced cavitational osteonecrosis exists, the few published research papers reveal it is true. These lesions go undetected because they usually do not develop immediately after the bone insult. And most importantly, various diseases and pain can manifest in other areas of the body than the jawbone. The medical literature needs more documented cases from researchers to wake up the healthcare professionals who are the ones to treat this problem.
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